Individual
MELISSA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
6002172
Contact information
Practice address
6141 BASSWOOD DR, COLUMBUS, IN 47201-8431
(812) 603-6827
Mailing address
719 5TH ST, COLUMBUS, IN 47201-6306
(812) 372-1571
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005724A
IN
1041C0700X
Clinical Social Worker
C003571
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6002172
—
NC
Enumeration date
11/10/2006
Last updated
03/30/2016
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